Provider Demographics
NPI:1598313777
Name:BROWN, JAKEMMA MCDANIEL (SLP)
Entity Type:Individual
Prefix:MS
First Name:JAKEMMA
Middle Name:MCDANIEL
Last Name:BROWN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:JAKEMMA
Other - Middle Name:LASHANEK
Other - Last Name:MCDANIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLPA
Mailing Address - Street 1:114 FALLS STREET
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29702
Mailing Address - Country:US
Mailing Address - Phone:704-240-7406
Mailing Address - Fax:866-897-4727
Practice Address - Street 1:114 FALLS STREET
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:SC
Practice Address - Zip Code:29702
Practice Address - Country:US
Practice Address - Phone:803-203-2864
Practice Address - Fax:866-897-4727
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-30
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC57552355S0801X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant